Provider Demographics
NPI:1235558859
Name:ASBAC PHARMACY DBA MED CARE PHARMACY
Entity Type:Organization
Organization Name:ASBAC PHARMACY DBA MED CARE PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:DEVINS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:760-758-7650
Mailing Address - Street 1:161 THUNDER DR
Mailing Address - Street 2:SUITE #100
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92083-6016
Mailing Address - Country:US
Mailing Address - Phone:760-758-7650
Mailing Address - Fax:760-758-8228
Practice Address - Street 1:161 THUNDER DR
Practice Address - Street 2:SUITE #100
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-6016
Practice Address - Country:US
Practice Address - Phone:760-758-7650
Practice Address - Fax:760-758-8228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-10
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHA482370333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PHA482370OtherPHARMACY LICENSE NUMBER
CAPHA482370Medicaid